Association of Preoperative Platelet-to-Lymphocyte Ratio with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery.

OBJECTIVE: The aim of this study was to investigate the association between platelet-to-lymphocyte ratio (PLR) and atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery. SUBJECTS AND METHODS: A total of 125 patients were retrospectively analyzed. AF was diagnosed using standard clinical criteria, and PLR was calculated as the ratio of the platelets to lymphocytes, obtained from the blood samples that were taken in the fasting state before CABG surgery. The association of different variables with postoperative AF and PLR was calculated using univariate and multivariate analysis. The receiver operating characteristics curve was used to determine the sensitivity and specificity of PLR and the optimal cutoff value for predicting post-CABG AF. RESULTS: Of the 125 patients, 50 with AF (mean age: 67.0 ± 9.5 years, 38 males and 12 females) and 75 patients without AF (mean age: 61.1 ± 9.1 years, 58 males and 17 females) were identified, and the difference in the mean age was statistically significant (p = 0.01). PLR was also significantly higher in those with AF (152.8 ± 82.2) than those without AF (118.2 ± 32.9) (p = 0.012). Univariate analysis showed that age and PLR were associated with AF after CABG surgery (p < 0.001 and p = 0.005, respectively). Using a multivariate logistic regression model with the backward elimination method, age and PLR remained as independent predictors of AF after CABG surgery (p < 0.001 and p = 0.005, respectively). PLR levels >119.3 predicted postoperative AF with 64% sensitivity and 56% specificity (AUC: 0.634, p = 0.012). CONCLUSION: In this study, age and PLR level were independent predictors of AF after CABG surgery. Patients with an elevated preoperative PLR were at higher risk of AF after CABG surgery.

Simultaneous Use of Intravenous Lipid Emulsion and Plasma Exchange Therapies in Multiple Drug Toxicity.

OBJECTIVE: The aim of this study was to highlight the use of combined intravenous lipid emulsion (ILE) and plasma exchange (PE) therapies in multidrug toxicity. CLINICAL PRESENTATION AND INTERVENTION: A 45-year-old woman who attempted suicide by ingesting large quantities of amisulpride (28 g), diazepam (250 mg), valsartan (2,240 mg), aripiprazole (45 mg) and paliperidone (21 mg) was taken to the hospital of Adnan Menderes University School of Medicine. Upon arrival, she exhibited signs of cardiotoxicity and severe depression of the central nervous and respiratory systems. She was treated successfully with ILE for 4 h and PE therapy for 36 h, consecutively. She was discharged on the fourth day of hospitalization having fully recovered. CONCLUSION: The patient was successfully treated with the combination of ILE and PE.

Metformin improves endothelial function and carotid intima media thickness in patients with PCOS.

OBJECTIVE: Oral contraceptive pills (OCP) are widely used for treating women with polycystic ovary syndrome (PCOS). Metformin has beneficial effects on insulin resistance and endothelial functions. The aim of this study was to investigate the effects of treatment with drospirenone/ethinyl estradiol (EE) alone or in combination with metformin on the flow-mediated vasodilatation (FMD) and carotid intima media thickness (CIMT) in women with PCOS. METHODS: Fifty women with PCOS (mean age 23 ± 5) were randomized to oral treatment of OCP alone (n = 25) or an OCP combination with metformin (n = 25) for 6 months. FMD from the brachial artery and CIMT were calculated. The hormonal profile, HOMA-IR score, basal insulin and glucose levels were studied in both groups. Before and after 6 months' treatment, echocardiographic measurements and laboratory tests were also obtained. RESULTS: After 6 months' treatment we observed a small decrease in FMD in the OCP group (14.9 ± 9.4 versus 14.4 ± 9.9, p = 0.801) and a slight increase in the combination group (14.5 ± 9.1 versus 15.0 ± 8.0, p = 0.715) but neither of them reached significance. CIMT increased in the OCP group (0.048 ± 0.011 to 0.050 ± 0.010 cm, p = 0.433) and decreased slightly in the combination group (0.049 ± 0.012, 0.048 ± 0.011 cm, p = 0.833). CONCLUSION: We demonstrated that adding metformin to OCP treatment may have beneficial effect on FMD and CIMT that represent vascular function in patients with PCOS. These results suggest that adding metformin to OCP treatment for PCOS could preserve the cardiovascular system and improve it.

Association of Left Atrial Spontaneous Echo Contrast to Uric Acid in Patients with Mitral Stenosis.

OBJECTIVES: Spontaneous echo contrast (SEC) is the presence of smoke-like echoes with a characteristic swirling motion of the blood in echocardiography. Previous clinical studies have shown that SEC is a risk factor for left atrial thrombus formation and a predictor of potential systemic embolism originating from the heart. There is an association between uric acid and prothrombotic state. Therefore, we aimed to investigate the role of uric acid in SEC in patients with mitral stenosis (MS). METHODS: A total of 85 consecutive patients with MS were enrolled in the study. Patients were divided into two groups according to whether SEC was present in the left atrium. RESULTS: There were 41 patients (mean age 46.4 ± 11.4 and 68% female) in the SEC(-) group and 44 patients (mean age 45.7 ± 7.2 and 64% female) in the SEC(+) group. High sensitive C-reactive protein (hs-CRP) levels were significantly higher in the SEC(+) group than in the SEC(-) group (9.5 ± 4.2 vs. 4.7 ± 2.2 mg/L, P < 0.001). Uric acid was also significantly higher in the SEC (+) group (6.3 ± 1.4 vs. 4.5 ± 1.3 mg/dL, P < 0.001). In receiver operating characteristics curve analysis, uric acid >5.2 mg/dL had a 73% sensitivity and 76% specificity in predicting SEC in patients with MS. At multivariate analysis, uric acid (OR 3.919, 95% CI 1.911-8.035; P < 0.002) was an independent risk factor for SEC in patients with MS. CONCLUSION: Uric acid is independently associated with SEC in patients with MS. Our findings suggest that this inexpensive, universally available marker may be a useful biomarker for the stratification of risk in patients with MS.

Neutrophil to lymphocyte ratio predicts SYNTAX score in patients with non-ST segment elevation myocardial infarction.

In this study we aimed to investigate whether there is an association between the neutrophil to lymphocyte ratio (NLR) and severity of coronary artery disease (CAD) in patients with non-ST segment elevation myocardial infarction (NSTEMI) using the SYNTAX score (SXscore). A total of 414 patients with NSTEMI who underwent coronary angiography were enrolled in the study. NLR was measured for all patients at presentation. The study population was then divided into 3 tertiles based on the SYNTAX trial results.(1)) The low syntax group (n = 329) was defined as those with an SXscore ≤ 22, the intermediate syntax group (n = 58) was defined as an SXscore ≥ 23 and < 33, and the high syntax group (n = 27) as those with an SXscore ≥ 33. NLR was significantly lower in patients with a low SXscore compared to patients with an intermediate SXscore or high SXscore (3.7 ± 4 to 4.6 ± 2 and 7.9 ± 4, P < 0.001). Linear regression analysis revealed that NLR (coefficientß = 0.380, 95%CI: 1.165-1.917, P < 0.001) was significantly associated with the SXscore in patients with NSTEMI. Our results indicate that NLR is independently associated with the severity of CAD in patients with NSTEMI.

Association of red blood cell distribution width levels with severity of coronary artery disease in patients with non-ST elevation myocardial infarction.

OBJECTIVES: The aim of this study was to evaluate the association of the levels of red blood cell distribution width (RDW) with the severity of atherosclerosis and to determine whether or not the RDW level on admission is an independent predictor of all-cause mortality in patients with non-ST elevation myocardial infarction (NSTEMI). MATERIALS AND METHODS: A total of 335 consecutive patients with NSTEMI were enrolled in this study. The patients were divided into high (n = 105) and low (n = 230) SYNTAX groups. The high SYNTAX group was defined as patients with a value in the third tertile (SYNTAX score, SXscore ≥12), while the low SYNTAX group was defined as those with a value in the lower 2 tertiles (SXscore <12). The high RDW group (n = 152) was defined as patients with RDW >14.25% and the low RDW group (n = 183) as those with RDW ≤14.25%. All-cause mortality was followed up to 38 months. RESULTS: The mean follow-up period was 18 ± 11 months. The RDW levels of patients were significantly higher in the high SYNTAX group than in the low SYNTAX group (15.2 ± 1.8 vs. 14.2 ± 1.2, p < 0.001). Pearson's coefficients were used to determine the degree of association between RDW levels and SXscore and also between RDW levels and high-sensitivity C-reactive protein. There was a significant correlation between RDW levels and SXscore (r = 0.460, p < 0.001). Also, there was a significant correlation between RDW levels and high-sensitivity C-reactive protein (r = 0.180, p = 0.001). All-cause mortality rate was not significantly different between the high and low RDW groups (log-rank, p = 0.621). CONCLUSION: RDW levels were independently associated with high SXscore but were not associated with long-term mortality in NSTEMI patients.

Hypertensive response to exercise in dipper and non-dipper normotensive diabetics.

Non-dipper blood pressure (NDP) as an indicator of autonomic dysfunction could be associated with hypertensive response to exercise (HRE) in diabetic patients. HRE was determined as a predictor of development of unborn hypertension. We aimed to investigate if any correlation among NDP and HRE in normotensive type 2 diabetic patients. A total of 59 consecutive type 2 diabetic patients without history of hypertension and with normal blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) were enrolled to the study. We divided the study population in to two groups depending on their BP on ABPM as dipper (group 1) or non-dipper (group 2). There were 22 patients (mean age 49.5 ± 7 and 10 male) in group 1 and 37 patients (mean age 53.1 ± 10 and 14 male) in group 2. Daytime diastolic and mean BP of dippers and night time systolic and mean BP of non-dippers were significantly higher. HRE was not significantly different between groups (59% vs. 62%, p = 0.820). Hemodynamic parameters during the exercise test were similar. At multivariate linear regression analysis, resting office systolic blood pressure (SBP) (r = 0.611, p < 0.001), male sex (r = 0.266, p = 0.002) and age (r = 0.321, p = 0.010) were independently correlated with peak exercises SBP. Logistic regression analyses identified the resting office SBP (OR 1.191, 95% CI 1.080-1.313; p < 0.001) and age (OR 1.161, 95% CI 1.038-1.298; p = 0.012) were independent predictors of HRE. This study revealed that HRE is not related with non-dipper BP in diabetic patients. This study could inspire to further studies to explore the main reasons of HRE in diabetes mellitus.

Mean platelet volume levels predict pulmonary artery hypertension in patients with atrial septal defect.

INTRODUCTION: Some reports have shown increased platelet aggregation and activation in patients with pulmonary artery hypertension (PAH). Mean platelet volume (MPV) is a simple and easy method of assessing platelet function. We aimed to investigate the mean platelet volume levels in patients with atrial septal defect (ASD) and the association between MPV levels and pulmonary artery hypertension. METHOD: One hundred and forty consecutive patients (42 males and mean age 35 +/- 9 y) and forty healthy controls (15 males and mean age 35 +/- 4 y) were enrolled in the study between December 2008 and February 2011. RESULTS: The ASD group demonstrated a significantly higher right ventricular size and pulmonary artery pressure than the control group (42 +/- 4 mm vs. 36 +/- 3 mm and 43 +/- 12 mmHg vs. 32 +/- 11 mmHg; P < 0.001 and P < 0.001, respectively). MPV levels were higher in the ASD group than the control group (9.3 +/- 1.2 fl vs. 8.6 +/- 0.8 fl, P < 0.001). There was a significant, positive correlation between MPV and systolic pulmonary artery pressure (PAP) (r = 0.542 and P < 0.001) in the ASD group. MPV was also significantly correlated with right ventricular size but not ASD diameter in the ASD group (r = 0.441, P < 0.001 and r = 0.126, P = 0.268, respectively). In receiver operating characteristics curve analysis, the cut-off value of MPV levels was > 8.7 fl and had 82% sensitivity and 63% specificity in predicting pulmonary artery hypertension. CONCLUSION: In the present study, we found that MPV levels, an indicator of platelet activation, were significantly higher in patients with ASD and correlated with systolic pulmonary artery pressure and right ventricular diameter.

Blood pressure response to exercise is exaggerated in normotensive diabetic patients.

INTRODUCTION: The aim of this study was to investigate the blood pressure (BP) response to exercise in normotensive patients with type II diabetes mellitus (DM). MATERIALS AND METHODS: A cross-sectional study was carried out on 75 normotensive subjects with type 2 DM (group 1), and 70 age-gender matched normotensive healthy volunteers (group 2). Treadmill exercise test, 24-h ambulatory BP monitoring (ABPM) were performed for each patients and healthy volunteers. RESULTS: There were 67 patients (mean age 52 ± 9 years and 42% male) in group 1 and 68 healthy volunteers (mean age 51 ± 7 years and 43% male) in group 2. Eight patients from group 1 and 2 subjects from group 2 were excluded because of high BP on ABPM. Groups were similar for systolic BP (SBP) and diastolic BP (DBP) on office measurements and on ABPM. Groups were similar for rest SBP, DBP, heart rate, exercise duration on exercise test. Peak SBP was significantly higher in group 1 than in group 2, but peak DBP was not (196.9 ± 18 vs 165.9 ± 18.6 mmHg, p<0.001; 88.1 ± 11.6 vs 86.2 ± 8.7 mmHg, p = 0.283, respectively). Hypertensive response to exercise (HRE) was more frequent in group 1 than in group 2 [39 (58%) vs 6 (9%), p<0.001]. Independent predictors of peak SBP were DM, office SBP and male gender, while independent predictors of HRE were DM, office SBP and age in multivariate analysis. CONCLUSIONS: SBP response to exercise is exaggerated in normotensive diabetic patients compared with non-diabetic subjects. DM, office SBP and male gender are independent predictors of peak SBP. DM, office SBP and age are independent predictors of HRE.

The lack of benefit of a combination of an angiotensin receptor blocker and calcium channel blocker on contrast-induced nephropathy in patients with chronic kidney disease.

AIM: Contrast-induced nephropathy (CIN) is a relatively common and serious complication, which occurs after the administration of contrast materials to patients. Although the pathophysiology of CIN is not exactly understood, ischemia of the medulla, oxidative stress, and direct toxicity of the contrast material are some of the factors that are implicated for the pathogenesis of CIN. To date, the only therapy that reduces the risk of CIN is volume expansion. There are conflicting results about the roles of angiotensin receptor blockers (ARB) and calcium channel blockers (CCB) in studies on CIN. For this reason the aim of this study was to compare the efficiency of the prophylactic use of amlodipine/valsartan plus hydration versus hydration only for the prevention of CIN in patients undergoing coronary angiography (CAG). PATIENTS AND METHODS: We prospectively enrolled 90 patients whose baseline serum creatinine levels were under 2.1 mg/dL and who were scheduled for CAG. Patients were divided into two groups. Group I (n = 45), consisted of patients who received amlodipine/valsartan plus hydration, group II (n = 45) consisted of patients who received only hydration. The patients in group I were given amlodipine/valsartan 5/160 mg once a day for a total of 3 days, starting one day before CAG and continuing on the day of and the day after the procedure. A 1 mL/kg/h sodium chloride infusion was administered for a total of 24 h, starting 12 h before the procedure and 12 h after, in all patients. The baseline serum creatinine (Scre) level was obtained before the procedure and repeated 48 h after. CIN was defined as an increase of ≥0.5 mg/dL or an increase of >25% in baseline Scre on the second day after CAG. RESULTS: The baseline clinical characteristics of the treatment groups were similar. Baseline Scre was 1.13 ± 0.33 in group I and 1.07 ± 0.23 mg/dL in group II (p = 0.31). There was a significant difference between the Scre levels 48 h after CAG between the two groups (1.18 ± 0.33-1.05 ± 0.23) (p = 0.03). The reason for this was the increase of Scre in group I. CIN occurred in 17.8% (8/45) of patients in group I and in 6.7% (3/45) of patients in group II (p = 0.197). In the diabetic subgroup, CIN occurred in 10.5% (2/19) of patients taking amlodipine/valsartan and in none of the patients in group II (p = 0.486). The Mehran scores of the patients who developed CIN were significantly higher than those patients who did not develop CIN. CONCLUSION: Amlodipine/valsartan therapy plus hydration did not reduce the risk of CIN in chronic kidney disease (CKD) Stage 2 patients who underwent elective CAG using a low-osmolar nonionic contrast medium. This is because there was a decrease in the glomerular filtration rate (GFR) using the Levey Modification of Diet in Renal Disease (MDRD) formula in the amlodipine/valsartan group and CIN occurred at a higher frequency in this group; ARBs and CCBs may be withheld before CAG in high-risk patients.

Heart rate recovery is impaired in patients with psoriasis.

OBJECTIVE: The aim of this study was to investigate the relationship between psoriasis and heart rate recovery (HRR) index. PATIENTS AND METHODS: A total of 50 patients with a diagnosis of psoriasis and 32 healthy volunteers were included in the study. In all patients, a stress test was performed to calculate the HRR index in a manner which aimed to reach the age-specific maximum heart rate. HRR indices were calculated in all patients and controls. RESULTS: HRR (beats/minute) indices after the 1st (HRR1, 26 ± 10 vs. 33 ± 8, p = 0.002), 2nd (44 ± 11 vs. 50 ± 6, p = 0.002), 3rd (51 ± 7 vs. 63 ± 8, p < 0.001), 4th (54 ± 7 vs. 65 ± 8, p < 0.001) and 5th (57 ± 8 vs. 70 ± 10, p < 0.001) minutes of the recovery period were significantly lower in the psoriasis group compared to healthy controls. In addition, HRR1 was significantly correlated with duration of psoriasis (r = 0.541, p < 0.001) and psoriasis area and severity index score (r = 0.511, p < 0.001). CONCLUSION: HRR was lower in patients with psoriasis. Given the prognostic value of this test, patients with psoriasis might be at risk for future cardiovascular events and cardiovascular mortality.

Increased serum asymmetric dimethylarginine level is an independent predictor of contrast-induced nephropathy.

OBJECTIVES: The aim of our study was to evaluate whether serum asymmetric dimethylarginine (ADMA) level is an independent predictor of contrast-induced nephropathy (CIN). STUDY DESIGN: The study involved 90 consecutive patients with stable angina pectoris who underwent coronary angiography and ventriculography. Baseline serum creatinine (SCr) levels ranged between ≥1.2 and <2 mg/dl. All patients were hydrated with intravenous isotonic saline at a rate of 1 ml/kg per hour for 6 hours before and 12 hours after the procedure. The primary end point was the occurrence of CIN. The secondary end point was the change in SCr levels at day 2 after the contrast exposure. Serum ADMA was determined by the ELISA method. RESULTS: The CIN rate was 11.1%. We detected a statistically significantly higher serum ADMA level in the CIN(+) group compared to that of the CIN(-) group [210.6 ng/ml (115.6-217.2) vs. 91.5 ng/ml (65.2-122.1), p=0.01]. Mehran risk score and diabetes mellitus (DM) ratio were higher in the CIN(+) group compared to those values in the CIN(-) group [8 (5.75-10) vs. 5 (5-7), p=0.01 and 70% vs. 26.3%, p=0.01, respectively]. Serum ADMA level, Mehran risk score and DM were independent predictors of CIN (odds ratio (OR) 1.030, 95% confidence interval (CI) 1.011-1.050, p=0.002; OR 1.565, 95% CI 1.102-2.223, p=0.012; OR 9.422, 95% CI 1.441-61.598, p=0.019, respectively). A serum ADMA level of >124.7 ng/ml had 80% sensitivity and 76% specificity in predicting the development of CIN. In addition, we found a positive correlation between SCr change and serum ADMA level (p=0.001, r=0.35). CONCLUSION: Our study demonstrates that increased serum ADMA level is an independent predictor of CIN.

No relevant association between coronary artery ectasia and mean platelet volume, gamma-glutamyltransferase and uric acid levels.

OBJECTIVES: In this study, we aimed to investigate whether there is an association between mean platelet volume (MPV), gamma-glutamyltransferase (GGT) and uric acid and coronary artery ectasia (CAE) in a large patient population. STUDY DESIGN: A total of 406 patients (245 male, 161 female; mean age: 55±9 years) were selected retrospectively as the study population from among 3265 individuals who underwent coronary angiography between August 2011 and December 2012. Information regarding blood tests of the patients obtained during hospitalization was extracted from the institute electronic database. RESULTS: MPV, GGT and uric acid levels were significantly higher in subjects with stenotic coronary artery disease (CAD) and in subjects with both CAD and CAE compared with subjects with isolated CAE and subjects with normal coronary arteries (NCA). There were no significant differences between the isolated CAE and NCA groups in terms of MPV (8.6±1.2 fL vs. 8.6±1.1, respectively, p=0.993), serum GGT (33±15 U/L vs. 30±15 U/L, respectively, p=0.723) and uric acid levels (5.4±1.6 mg/dl vs. 5.2±1.7 mg/dl, respectively, p=0.845). CONCLUSION: Unlike previous studies, our study failed to demonstrate any association between CAE and MPV, uric acid and GGT levels.

The effects of treatment with drospirenone/ethinyl oestradiol alone or in combination with metformin on elastic properties of aorta in women with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a heterogeneous clinical condition. Oral contraceptive pills (OCPs) have conventionally been the mainstay of treatment for the amelioration of hyperandrogenism and regulation of menstrual cycles in women with PCOS. Metformin has beneficial effects on insulin resistance and endothelial functions. To our knowledge, the effect of metformin/OCP combination treatment on aortic stiffness has not been studied so far. OBJECTIVE: The aim of this study was to investigate the effects of treatment with drospirenone/ethinyl oestradiol (E/E) alone or in combination with metformin on the elastic properties of the aorta in women with PCOS. METHODS: Thirty-seven women with PCOS were enrolled in the study. The first treatment arm, which was treated with OCP alone, was described as the OCP group (19 patients, mean age: 23·2 ± 5·4); the other treatment arm, which was treated with OCP and metformin, was described as the combination group (18 patients, mean age: 23·0 ± 4·5). The elastic parameters of the aorta namely 'aortic strain', 'aortic distensibility', 'aortic diameter alteration' and 'aortic stiffness index' were calculated by the appropriate formulae. The hormonal profile, HOMA-IR score, basal insulin and glucose levels were studied in both groups. Before and after 6 months of treatment, echocardiographic measurements and laboratory tests were also obtained. RESULTS: After 6 months of treatment, significant weight loss and decrease in body mass index (BMI) were observed in the combination group (75·3 ± 13·3 kg to 72·3 ± 13·5 kg and 31·7 ± 7·3 kg/m² vs 30·4 ± 7·3 kg/m², P = 0·001 and P = 0·001, respectively). Conversely in the OCP group, BMI and weight were not significantly different after 6 months of treatment (68·8 ± 18·3 kg to 71·6 ± 21·2 kg and 26·4 ± 6·2 kg/m² to 27·4 ± 6·9 kg/m², P = 0·159 and P = 0·149, respectively). In addition, there were no significant differences in aortic strain, distensibility (7·7 ± 4·2 to 7·8 ± 3·6 and 7·2 ± 4·1 to 7·7 ± 3·6, P = 0·926 and P = 0·593, respectively) and stiffness index in the OCP group (8·8 ± 7·4 to 8·2 ± 6·7, P = 0·772). However, in the combination group, the adjusted values of the aortic stiffness index decreased significantly at the 6 months' follow-up (10·0 ± 1·5 to 6·7 ± 0·3, P = 0·021) and aortic distensibility and strain increased but not significantly (7·0 ± 4·3 to 9·3 ± 3·3 and 6·8 ± 3·9 to 9·4 ± 3·5, P = 0·163 and P = 0·071, respectively) at the 6 months' follow-up. CONCLUSION: We demonstrated an improvement in the elastic parameters of the aorta by adding metformin to OCP treatment. We suggest that metformin plus OCP treatment may decrease cardiovascular disease risk in women with PCOS.

Early arterial stiffness and inflammatory bio-markers in normotensive polycystic kidney disease patients.

BACKGROUND/AIMS: Cardiovascular disease is the main cause of morbidity and mortality in autosomal-dominant polycystic kidney disease (ADPKD) patients. To clarify temporal relationship between ADPKD, hypertension and the loss of renal function, we examined these factors in patients with early-stage ADPKD who did not yet have hypertension. METHODS: Fifty patients with ADPKD (42% males, 36.6 ± 9.9 years, no blood pressure medication) and 50 healthy controls (44% males, 35.4 ± 6.4 years) were studied cross-sectionally. Pulse wave velocity (PWV), cardiac morphology and function, aortic elastic indexes, estimated glomerular filtration rate (eGFR), 24-hour ambulatory blood pressure, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and highly sensitive C-reactive protein (hs-CRP) were measured in all participants, using conventional methods. RESULTS: Despite a normal blood pressure, aortic stiffness index and pulse wave velocity values were increased in patients compared to controls (6.8 ± 4.7 vs. 5.1 ± 3.3, p = 0.043 and 9.6 ± 1.3 vs. 5.8 ± 1.1 m/s, p < 0.001). In univariate analysis, IL-6, TNF-α, hs-CRP and eGFR were all significantly correlated with PWV. The independence of these correlations were analyzed in a regression model, and showed PWV to be significantly predicted by IL-6, TNF-α and hs-CRP. CONCLUSION: Increased arterial stiffness and pulse wave velocity are early manifestations of ADPKD appearing before hypertension or reduced eGFR. However, these vascular abnormalities are related to signs of systemic low grade inflammation, suggesting a common pathophysiological mechanism apparently present also in other vascular diseases but yet to be elucidated.

Red blood cell distribution width in 'non-dippers' versus 'dippers'.

OBJECTIVES: Because both high red cell distribution width (RDW) and non-dipping hypertension are closely related to adverse cardiovascular outcomes and higher inflammatory status, we aimed to investigate whether there is any relationship between RDW and dipping/non-dipping hypertension status. METHODS: The present study involved 123 hypertensive patients and 65 age- and gender-matched healthy, normotensive subjects. Hypertensive patients were divided into two groups: 56 dipper patients (20 males, mean age 51.9 ± 15.3 years) and 67 non-dipper patients (27 males, mean age 55.6 ± 15.0 years). If the systolic daytime blood pressure (BP) of the patients decreased by at least 10% during the nighttime, these subjects were 'dippers', and all other subjects were 'non-dippers'. RESULTS: Both dipper patients and non-dipper patients had higher levels of RDW compared to normotensives (13.5 ± 0.89 and 14.1 ± 1.33 vs. 13.0 ± 1.42%, p = 0.027 and p < 0.001, respectively). Also RDW values in non-dippers were statistically higher compared to those in dippers (p = 0.008). Although there were negative correlations between RDW values and nocturnal systolic BP fall (p = 0.027, r = -0.199) and diastolic BP fall (p = 0.383, r = -0.079) in all hypertensive patients, these correlations did not reach a statistically significant level. CONCLUSION: Our study demonstrates that non-dippers have high RDW levels compared to both dippers and controls.

Assessment of aortic elastic properties in patients with sarcoidosis.

BACKGROUND: Sarcoidosis is an inflammatory granulomatous disease of unknown etiology that involves multiple organ systems. Many studies have shown a strong relationship between inflammation and atherosclerosis. The aim of this study is to investigate the relationship between elastic properties of the aorta and the duration of the disease in patients with sarcoidosis. METHOD: The study population included 52 patients with sarcoidosis (22 men, mean age = 42.7 ± 10.7 years, and mean disease duration = 38.8 ± 10.8 months) and 50 healthy control subjects (18 men, and mean age = 42.0 ± 8.0 years). Aortic stiffness (ß) index, aortic strain (AoS) and aortic distensibility (AoD) were calculated from the aortic diameters measured by transthoracic echocardiography and blood pressure obtained by sphygmomanometer. Cardiac functions were determined by using routine echocardiographic evaluation consist of standard two-dimensional and conventional Doppler and tissue Doppler imaging. RESULTS: The conventional echocardiographic parameters were similar between patients and controls. There were significant differences between the control and the patient groups in ß index (1.63 ± 0.55 vs 2.44 ± 1.54, p = 0.001), AoS (15.61 ± 5.69 vs 10.93 ± 4.11%, p < 0.001) and AoD (6.35 ± 2.64 vs 4.66 ± 1.98, 10 (-6) cm(2)/dyn, p = 0.001). There were statistically significant negative correlations between the disease duration and AoD (r = -0.46, p = 0.01) and AoS (r= -0.44, p = 0.002), whereas there was a positive correlation between the disease duration and ß index (r = 0.37, p = 0.01). In multivariate analysis, disease duration was significantly related with AoD, AoS and ß index (respectively, RR = 3.28, p = 0.002; RR = 3.03, p = 0.004; RR = 2.39, p = 0.02). CONCLUSION: We observed that elastic properties of the aorta alter in patients with sarcoidosis. We also have demonstrated a statistically significant correlation between aortic elastic properties and the disease duration.

Acute pericarditis during 5-fluorouracil, docetaxel and cisplatin therapy.

DCF chemotherapy regimen includes docetaxel, cisplatin, and 5-fluorouracil (5-FU). Cardiotoxicity is one of the well-known side effects of 5-FU, docetaxel, and cisplatin. In addition, the complications and side effects are more apparent when these three agents are given in combination. For the first time we describe a case of acute pericarditis associated with DCF regimen in a male patient. A 55-year-old man recently diagnosed with syncrone nasopharenx and non-small cell lung carcinoma was admitted to the oncology unit for chemotherapy. On the fourth day of infusion therapy with DCF he developed a central chest pain that was in pleuritic character and aggravated by recumbence. On electrocardiography (ECG), there was ST elevation on V2-6, D1, D2, and AVL. The patient was immediately transported to the cardiac catheterization laboratory for primary percutaneous coronary intervention. On coronary angiography, coronary arteries were normal. There was no segmentary wall motion abnormality on left ventricle in transthoracic echocardiography. The patient was diagnosed with acute pericarditis and the DCF regimen was discontinued. After 3 days, chest pain disappeared and ECG was normalized. According to the present case, the management of DCF-induced pericarditis includes stopping the drug and administering supportive treatment. The best method to prevent recurrent pericarditis induced by DCF is to use an alternate chemotherapeutic regimen.

Relationship between hematologic parameters and left ventricular systolic dysfunction in stable patients with multi-vessel coronary artery disease.

OBJECTIVES: Multi-vessel coronary artery disease (MVCAD) has long been recognized as an important predictor of adverse outcomes in patients with chronic stable angina. The aim of this study is to investigate the relationship between hematologic parameters and impairment of left ventricular systolic functions in patients with stable MVCAD. STUDY DESIGN: Patients (n=202) with stable angina and MVCAD were included in this study. According to the left ventricle ejection fraction (LVEF) determined by echocardiography, patients were divided into two groups as the preserved group (LVEF >50%) and the impaired group (LVEF <50%). The preserved group consisted of 106 patients and the impaired group consisted of 96 patients. RESULTS: The frequency of diabetes mellitus was significantly higher in the impaired group compared to the preserved group (respectively, 50% vs. 33%, p=0.01). High sensitivity C-reactive protein (hs-CRP) levels and, neutrophil/lymphocyte ratio (N/L ratio) were significantly higher in the impaired group than in the preserved group (3.9±2.4 vs. 7.9±3.8, p<0.001; 2.7±0.7 vs. 3.9±1.2, p<0.001, respectively). There was a significant correlation between LVEF, N/L ratio and hs-CRP; hs-CRP and N/L ratio were positively correlated (r=0.584; p<0.001), and LVEF was negatively correlated with both hs-CRP and N/L ratio (r=-0.48, p<0.001 and r=-0.43, p<0.001, respectively). A N/L ratio >3.0 had 77% sensitivity and 68% specificity in predicting left ventricular dysfunction in patients with stable MVCAD. In multivariate analysis, N/L ratio (OR: 2.456, <95% Cl 2.056-4.166; p<0.001) was an independent predictor of left ventricular dysfunction in stable patients with MVCAD. CONCLUSION: N/L ratio and hs-CRP, which is inexpensive and easily measurable in the laboratory, is independently associated with impaired LV systolic functions in patients with stable MVCAD.

The effects of significant coronary stenosis and percutaneous coronary intervention on aortic stiffness.

OBJECTIVES: Although aortic stiffness (AS) is a strong predictor of cardiovascular events, its value is unknown in patients who have coronary stenosis and undergo percutaneous coronary intervention (PCI). Our hypothesis was that AS might provide additional information about coronary hemodynamic status. In this context, we investigated the effects of coronary stenosis and PCI on AS. STUDY DESIGN: The study included 107 patients undergoing coronary angiography. The patients were divided into three groups based on the angiographic results: 39 patients with significant lesions (≥50%) formed the 'critical group' and 38 patients with nonsignificant lesions (<50%) formed the 'noncritical group'. The control group (30 patients) had normal angiograms. Aortic stiffness was determined using the carotid-femoral aortic pulse wave velocity (PWV) method. All patients in the critical group underwent successful PCI and repeat PWV measurements. RESULTS: All baseline characteristics were similar in the three groups except for the mean PWV, which was significantly higher (9.4±2.2 m/sec) in the critical group compared to the control group (5.7±1.1 m/sec) and the noncritical group (5.8±1.1 m/sec) (p<0.0001). The latter two groups had similar PWV values (p=0.6). After PCI, the mean PWV decreased significantly by 24.4% to 7.1±2.0 m/sec (p=0.002); however, it was still significantly higher than that of the control group (p<0.0001). In correlation analysis, PWV showed significant correlations with age (r=0.412, p=0.01), systolic blood pressure (r=0.342, p<0.01), and hemoglobin (r=-0.370, p=0.02). Multiple logistic regression analysis showed that PWV was a predictor for significant stenosis [Exp(B) 3.960, 95% CI 2.014-7.786]. CONCLUSION: Our findings suggest that significant coronary stenosis is associated with significantly increased AS and successful PCI improves AS to some extent.